Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Implant MiniBunion Non-Locking Screw 2.7mm x 16mm

Facility

$697.00

Hospital Charge Code	3258354
Hospital Revenue Code	270
Min. Negotiated Rate	$278.80
Max. Negotiated Rate	$662.15
Rate for Payer: Aetna Commercial	$627.30
Rate for Payer: Humana Medicare Advantage	$292.74
Rate for Payer: UnitedHealthcare Commercial	$662.15
Rate for Payer: UnitedHealthcare Medicaid	$278.80
Rate for Payer: WPPA Medicare Advantage	$418.20

Implant MotoBAND Non-Locking Screw 3.0mm x 10mm

Facility

$473.00

Hospital Charge Code	3258344
Hospital Revenue Code	270
Min. Negotiated Rate	$425.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$425.70
Rate for Payer: UnitedHealthcare Commercial	$449.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant MotoBAND Non-Locking Screw 3.0mm x 10mm

Facility

$473.00

Hospital Charge Code	3258344
Hospital Revenue Code	270
Min. Negotiated Rate	$189.20
Max. Negotiated Rate	$449.35
Rate for Payer: Aetna Commercial	$425.70
Rate for Payer: Humana Medicare Advantage	$198.66
Rate for Payer: UnitedHealthcare Commercial	$449.35
Rate for Payer: UnitedHealthcare Medicaid	$189.20
Rate for Payer: WPPA Medicare Advantage	$283.80

Implant MotoBAND Non-Locking Screw 3.0mm x 14mm

Facility

$473.00

Hospital Charge Code	3258346
Hospital Revenue Code	270
Min. Negotiated Rate	$189.20
Max. Negotiated Rate	$449.35
Rate for Payer: Aetna Commercial	$425.70
Rate for Payer: Humana Medicare Advantage	$198.66
Rate for Payer: UnitedHealthcare Commercial	$449.35
Rate for Payer: UnitedHealthcare Medicaid	$189.20
Rate for Payer: WPPA Medicare Advantage	$283.80

Implant MotoBAND Non-Locking Screw 3.0mm x 14mm

Facility

$473.00

Hospital Charge Code	3258346
Hospital Revenue Code	270
Min. Negotiated Rate	$425.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$425.70
Rate for Payer: UnitedHealthcare Commercial	$449.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant MotoBAND Non-Locking Screw 3.0mm x 16mm

Facility

$473.00

Hospital Charge Code	3258345
Hospital Revenue Code	270
Min. Negotiated Rate	$425.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$425.70
Rate for Payer: UnitedHealthcare Commercial	$449.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant MotoBAND Non-Locking Screw 3.0mm x 16mm

Facility

$473.00

Hospital Charge Code	3258345
Hospital Revenue Code	270
Min. Negotiated Rate	$189.20
Max. Negotiated Rate	$449.35
Rate for Payer: Aetna Commercial	$425.70
Rate for Payer: Humana Medicare Advantage	$198.66
Rate for Payer: UnitedHealthcare Commercial	$449.35
Rate for Payer: UnitedHealthcare Medicaid	$189.20
Rate for Payer: WPPA Medicare Advantage	$283.80

Implant MotoBAND Non-Locking Screw 3.0mm x 18mm

Facility

$473.00

Hospital Charge Code	3258336
Hospital Revenue Code	270
Min. Negotiated Rate	$425.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$425.70
Rate for Payer: UnitedHealthcare Commercial	$449.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant MotoBAND Non-Locking Screw 3.0mm x 18mm

Facility

$473.00

Hospital Charge Code	3258336
Hospital Revenue Code	270
Min. Negotiated Rate	$189.20
Max. Negotiated Rate	$449.35
Rate for Payer: Aetna Commercial	$425.70
Rate for Payer: Humana Medicare Advantage	$198.66
Rate for Payer: UnitedHealthcare Commercial	$449.35
Rate for Payer: UnitedHealthcare Medicaid	$189.20
Rate for Payer: WPPA Medicare Advantage	$283.80

Implant MotoBAND Non-Locking Screw 3.0mm x 20mm

Facility

$473.00

Hospital Charge Code	3258337
Hospital Revenue Code	270
Min. Negotiated Rate	$425.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$425.70
Rate for Payer: UnitedHealthcare Commercial	$449.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant MotoBAND Non-Locking Screw 3.0mm x 20mm

Facility

$473.00

Hospital Charge Code	3258337
Hospital Revenue Code	270
Min. Negotiated Rate	$189.20
Max. Negotiated Rate	$449.35
Rate for Payer: Aetna Commercial	$425.70
Rate for Payer: Humana Medicare Advantage	$198.66
Rate for Payer: UnitedHealthcare Commercial	$449.35
Rate for Payer: UnitedHealthcare Medicaid	$189.20
Rate for Payer: WPPA Medicare Advantage	$283.80

Implant MotoBAND Non-Locking Screw 3.0mm x 22mm

Facility

$473.00

Hospital Charge Code	3258334
Hospital Revenue Code	270
Min. Negotiated Rate	$425.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$425.70
Rate for Payer: UnitedHealthcare Commercial	$449.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant MotoBAND Non-Locking Screw 3.0mm x 22mm

Facility

$473.00

Hospital Charge Code	3258334
Hospital Revenue Code	270
Min. Negotiated Rate	$189.20
Max. Negotiated Rate	$449.35
Rate for Payer: Aetna Commercial	$425.70
Rate for Payer: Humana Medicare Advantage	$198.66
Rate for Payer: UnitedHealthcare Commercial	$449.35
Rate for Payer: UnitedHealthcare Medicaid	$189.20
Rate for Payer: WPPA Medicare Advantage	$283.80

Implant MotoClip Max 9mm x 9mm x 9mm

Facility

$4,190.00

Service Code	HCPCS C1776
Hospital Charge Code	3258380
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,980.50
Rate for Payer: Aetna Commercial	$3,771.00
Rate for Payer: UnitedHealthcare Commercial	$3,980.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant MotoClip Max 9mm x 9mm x 9mm

Facility

$4,190.00

Service Code	HCPCS C1776
Hospital Charge Code	3258380
Hospital Revenue Code	278
Min. Negotiated Rate	$1,676.00
Max. Negotiated Rate	$3,980.50
Rate for Payer: Aetna Commercial	$3,771.00
Rate for Payer: Humana Medicare Advantage	$1,759.80
Rate for Payer: UnitedHealthcare Commercial	$3,980.50
Rate for Payer: UnitedHealthcare Medicaid	$1,676.00
Rate for Payer: WPPA Medicare Advantage	$2,514.00

Implant Screw 2.5mm x 32mm Headed Cannulated Short Screw

Facility

$451.20

Hospital Charge Code	3258575
Hospital Revenue Code	270
Min. Negotiated Rate	$406.08
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$406.08
Rate for Payer: UnitedHealthcare Commercial	$428.64
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant Screw 2.5mm x 32mm Headed Cannulated Short Screw

Facility

$451.20

Hospital Charge Code	3258575
Hospital Revenue Code	270
Min. Negotiated Rate	$180.48
Max. Negotiated Rate	$428.64
Rate for Payer: Aetna Commercial	$406.08
Rate for Payer: Humana Medicare Advantage	$189.50
Rate for Payer: UnitedHealthcare Commercial	$428.64
Rate for Payer: UnitedHealthcare Medicaid	$180.48
Rate for Payer: WPPA Medicare Advantage	$270.72

Implant Screw 2.5mm x 36mm Headed Cannulated Short Screw

Facility

$451.20

Hospital Charge Code	3258576
Hospital Revenue Code	270
Min. Negotiated Rate	$406.08
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$406.08
Rate for Payer: UnitedHealthcare Commercial	$428.64
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant Screw 2.5mm x 36mm Headed Cannulated Short Screw

Facility

$451.20

Hospital Charge Code	3258576
Hospital Revenue Code	270
Min. Negotiated Rate	$180.48
Max. Negotiated Rate	$428.64
Rate for Payer: Aetna Commercial	$406.08
Rate for Payer: Humana Medicare Advantage	$189.50
Rate for Payer: UnitedHealthcare Commercial	$428.64
Rate for Payer: UnitedHealthcare Medicaid	$180.48
Rate for Payer: WPPA Medicare Advantage	$270.72

Implant Screw Cannulated 3.0 mm x 22 mm Partially-Threaded Sterile

Facility

$507.60

Hospital Charge Code	3258572
Hospital Revenue Code	270
Min. Negotiated Rate	$203.04
Max. Negotiated Rate	$482.22
Rate for Payer: Aetna Commercial	$456.84
Rate for Payer: Humana Medicare Advantage	$213.19
Rate for Payer: UnitedHealthcare Commercial	$482.22
Rate for Payer: UnitedHealthcare Medicaid	$203.04
Rate for Payer: WPPA Medicare Advantage	$304.56

Implant Screw Cannulated 3.0 mm x 22 mm Partially-Threaded Sterile

Facility

$507.60

Hospital Charge Code	3258572
Hospital Revenue Code	270
Min. Negotiated Rate	$456.84
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$456.84
Rate for Payer: UnitedHealthcare Commercial	$482.22
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant Set Plantar Plate Lot #WM042796

Facility

$4,078.00

Hospital Charge Code	3258529
Hospital Revenue Code	270
Min. Negotiated Rate	$1,631.20
Max. Negotiated Rate	$3,874.10
Rate for Payer: Aetna Commercial	$3,670.20
Rate for Payer: Humana Medicare Advantage	$1,712.76
Rate for Payer: UnitedHealthcare Commercial	$3,874.10
Rate for Payer: UnitedHealthcare Medicaid	$1,631.20
Rate for Payer: WPPA Medicare Advantage	$2,446.80

Implant Set Plantar Plate Lot #WM042796

Facility

$4,078.00

Hospital Charge Code	3258529
Hospital Revenue Code	270
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,874.10
Rate for Payer: Aetna Commercial	$3,670.20
Rate for Payer: UnitedHealthcare Commercial	$3,874.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

INBORN AND OTHER DISORDERS OF METABOLISM

Facility

$6,195.15

Service Code	MSDRG 642
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,195.15
Rate for Payer: UnitedHealthcare Medicaid	$6,195.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Incentive Spirometer

Facility

$10.58

Hospital Charge Code	3251167
Hospital Revenue Code	270
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$10.05
Rate for Payer: Aetna Commercial	$9.52
Rate for Payer: Humana Medicare Advantage	$4.44
Rate for Payer: UnitedHealthcare Commercial	$10.05
Rate for Payer: UnitedHealthcare Medicaid	$4.23
Rate for Payer: WPPA Medicare Advantage	$6.35

Know your out-of-pocket cost for care.

All Charges